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Jay Louis Jordan

Internal Medicine

Allopathic & Osteopathic Physicians

8631 W 3rd St, Suite 445e, Los Angeles, CA 90048-5901

PECOS Enrollment

This provider is enrolled in PECOS as JAY JORDAN.

Based on the most recent information from CMS, provider Jay Louis Jordan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1265446371
Provider Type
Individual
Full Name
Jordan, Jay Louis
Credential
M.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
7/27/2006
Last Updated
1/7/2015

Contact Information

Practice Location

8631 W 3rd St, Suite 445e, Los Angeles, CA 90048-5901

(310) 854-5493

(310) 289-7941

Mailing Location

8631 W 3rd St, Suite 445e, Los Angeles, CA 90048-5901

(310) 854-5493

(310) 289-7941

Provider Taxonomies

Code	Description	License
Code 207RC0000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License A25646 California

Provider Identifiers

ID	Description	Issuer
ID BU936Z	Description Other	Issuer MEDICARE California

Jay Louis Jordan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Sedlak, Tara Leanne

Yzhar Charuzi, M.D.,

Hijazi, Waseem

Heikali, Daniel

Neumann, M M

Prohealth Partners A Medical Group

Charuzi, Yzhar

Robert M Davidson, M.D., Inc

Skaf, Sabah

Swaminatha V Gurudevan, Md, A Professional Corporation